CMS-0057-F Final Rule · CHIP fee-for-service

CMS-0057-F deadlines & requirements for CHIP fee-for-service

There are 12 tracked CMS-0057-F obligations for CHIP fee-for-service, with compliance dates from April 8, 2024 through January 1, 2028 — each traced to the Federal Register.

days
hours
minutes
until the January 1, 2027 Patient Access & Prior Authorization API compliance date for most impacted payers.
The calendar

Every CHIP fee-for-service compliance date

Only the CMS-0057-F obligations that apply to CHIP fee-for-service, grouped by date. Managed-care obligations key to the rating period on or after the date. Every row traced to the Federal Register.

April 8, 2024
2 obligations · already in force
Patient Access API — expanded data content (all USCDI data classes and elements per 45 CFR 170.213)
April 8, 2024 (effective date of the final rule; already in force)
CHIP fee-for-service 89 FR 8758
Rule effective 2024-04-08
All impacted payers 89 FR 8758
October 1, 2025
1 obligation · already in force
Rule effective 2025-10-01
All impacted payers 90 FR 36536
January 1, 2026
4 obligations · already in force
Annual public reporting of prior authorization metrics on payer website
Beginning in 2026; first public posting due March 31, 2026, covering calendar year 2025 data; recurring annually each March 31 for the prior calendar year
CHIP fee-for-service 89 FR 8758
Prior authorization decision timeframes (72 hours expedited / 7 calendar days standard)
On or after January 1, 2026
CHIP fee-for-service 89 FR 8758
Specific reason for prior authorization denial (any communication channel) CHIP fee-for-service 89 FR 8758
HL7 FHIR US Core IG 3.1.1 expires 2026-01-01
All impacted payers 89 FR 8758
March 31, 2026
4 obligations · already in force
Annual public reporting of prior authorization metrics on payer website
First report due 2026-03-31 (PAYER_WEBSITE)
All impacted payers 89 FR 8758
Annual public reporting of prior authorization metrics on payer website
Beginning in 2026; first public posting due March 31, 2026, covering calendar year 2025 data; recurring annually each March 31 for the prior calendar year
CHIP fee-for-service 89 FR 8758
Patient Access API usage metrics — annual report to CMS
First report due 2026-03-31 (CMS)
All impacted payers 89 FR 8758
Patient Access API usage metrics — annual report to CMS
Beginning in 2026: due March 31 each year for the previous calendar year (first report due March 31, 2026, covering CY2025)
CHIP fee-for-service 89 FR 8758
May 26, 2026
1 obligation · already in force
Rule effective 2026-05-26
All impacted payers 91 FR 14350
June 15, 2026
1 obligation · already in force
Comment period closes 2026-06-15
All impacted payers Proposed 91 FR 19890
January 1, 2027 Key deadline
4 obligations
Patient Access API — prior authorization information CHIP fee-for-service 89 FR 8758
Payer-to-Payer API
January 1, 2027 (one-time 1-year extension available, i.e. to January 1, 2028; 90%-MCO-enrollment exemption available)
CHIP fee-for-service 89 FR 8758
Prior Authorization API (CRD+DTR+PAS capability)
By January 1, 2027 (one-time 1-year extension available, i.e. to January 1, 2028; 90%-MCO-enrollment exemption available)
CHIP fee-for-service 89 FR 8758
Provider Access API
January 1, 2027 (one-time 1-year extension available, i.e. to January 1, 2028; 90%-MCO-enrollment exemption available)
CHIP fee-for-service 89 FR 8758
March 31, 2027
2 obligations
Annual public reporting of prior authorization metrics on payer website
Next annual 3/31 recurrence (PAYER_WEBSITE)
All impacted payers 89 FR 8758
Patient Access API usage metrics — annual report to CMS
Next annual 3/31 recurrence (CMS)
All impacted payers 89 FR 8758
October 1, 2027
2 obligations
Incorporate drugs covered under a medical benefit into the Prior Authorization API
October 1, 2027 (proposed)
CHIP fee-for-service Proposed 91 FR 19890
Prior authorization decision timeframes for drugs
October 1, 2027 (proposed)
CHIP fee-for-service Proposed 91 FR 19890
January 1, 2028
1 obligation
HL7 FHIR Da Vinci Prior Authorization Support (PAS) IG 2.0.1 expires 2028-01-01
All impacted payers 89 FR 8758
Other payer types

CMS-0057-F for other payer types

The same deadline detail, scoped to a different organization type.

Beyond the rulebook

Knowing the rules is the easy part. Who’s actually complying?

The deadlines above are public. What isn’t: which payers have already posted their prior-authorization metrics, and what they reported. Dataplex tracks that layer — human-reviewed and traced to each payer’s own published source.

475+payer organizations tracked
500+posted PA metrics, source-traced
  • See which of your competitors have posted — and their approval, denial, and appeal rates.
  • Every metric human-reviewed and linked to the payer’s own published page.
  • Benchmark your organization against the field, or embed the matrix in your own product.
Free download

The one-page milestone cheat sheet

Every key CMS-0057-F compliance date on a single printable page — what’s due, who it hits, traced to the Federal Register. We’ll email you the PDF and a note from our team.

No spam. One follow-up from a human, then only if you ask.
Dataplex maintains this tracker from the published Federal Register text of CMS-0057-F and adjacent rulemaking. It is a reference summary, not legal advice — verify against the citations shown. For payer benchmarking, the full provenance-traced matrix, or embedding it in your product, talk to our team. Teams who want to self-serve the queryable dataset can find it on the Snowflake Marketplace.